Lichen simplex chronicus

Patient 84 -year-old man who has a long-standing history of itching complaint for approximately 15 to 20 years. He states that this is a constant chronic itch, some days are worse than other, at times when he needs to be still like falling a sleep at night are the most troubling time with his itching. He has lived in various places in the last two years and it does not seem to matter with climate change or humid environment or dry climate the severity of his itching. He has tried multiple things in the past from various practitioners. He currently uses a skin hydration program with Cetaphil moisturizer after showering. He has used steroid creams that seemed to help although it can only be used sparingly. He has tried Benadryl at night that seems to help a little bit but it does seem to make him very groggy. He has not tried high doses of antihistamines in the past. He has been extensively worked up for kidney and liver issues as well as maintained regular blood work due to his age and other medical history complaints. All blood work is within normal limits that may be contributing to itching.

He does complain of some seasonal allergies. He does state that the winter season is the worst. He complains of nasal symptoms of sneezing, clear nasal discharge, postnasal drip, frequent nose blowing, mouth breathing at night, frequent throat clearing, itching inside ears, snoring and heartburn occasionally. He states that it can be approximately year round but worse in the winter. He denies problems of sinus infection, nasal polyps, aspirin-induced nasal symptoms, any nasal surgery, frequent bad cold, frequent tonsillitis or frequent ear infection.

He has used Flonase nasal spray in the past. He uses it as needed. He does feel that it helps very little.

He also complains of eye itching and burning, light hurting his eyes and eyelid irritation but denies redness, tearing dryness, yellow discharge from eyes or eyelids swelling. This occurs some of the time.

He denies any wheezing or lung problems or history of asthma. He has had a chest x-ray in the last five years done. He denies any other history of allergic skin problems although he does state when he was child he had intermittent hives particularly after eating citrus fruits and other fruits that has resolved and now he can tolerate fruits without getting hives. He has never been evaluated for allergies before.

ASSESSMENT:
1. Pruritus, unspecified.
2. Lichen simplex chronicus.
3. Allergic rhinitis.
4. Allergic conjunctivitis.
5. History of GERD, well controlled.
6. Coronary artery disease.
7. History of thyroid, vocal cord and skin cancer.

PLAN:
1. At this time, Dr. and I have encouraged him to try our skin hydration program with Olivamine cream and to practice bathing in lukewarm water, pat dry and use Aveeno oatmeal bath.
2. We also encouraged him to use Zyrtec 10 mg twice daily at this high dose to see if he responds to the antihistamine and reduces his itching complaint.
3. We will follow up in one month’s time to see if this plan has helped. If not, we may pursue skin testing in the future to seasonal allergens and possibly fruits as well. He can continue to use Flonase as needed as well for seasonal allergies.

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